title: Posttransplantation lymphoproliferative disorder in lung transplant recipients: a 15-year single institution experience.
abstract: BACKGROUND
  Posttransplantation lymphoproliferative disorder (PTLD) is a well-recognized complication after solid-organ transplantation. Historically, most cases of PTLD among lung transplant recipients occurred within the first year from transplantation and were associated with Epstein-Barr virus (EBV) infection. However, there are increasing reports on a late-onset form of PTLD.
  
  
  METHODS
  We reviewed all charts of patients undergoing either lung or heart-lung transplantation in a tertiary transplantation center between the years 1997 and 2012 and compared clinical and pathologic parameters between early- and late-onset PTLD.
  
  
  RESULTS
  Ten patients with PTLD were identified. Median (range) time from transplantation to PTLD diagnosis was 41 (4-128) months. Three patients developed early PTLD. All were pretransplantation EBV seronegative and asymptomatic when diagnosed during surveillance chest imaging. In contrast, the seven patients with late-onset PTLD were all EBV seropositive before transplantation and were symptomatic at diagnosis. Although early-onset PTLD uniformly involved the transplanted lung, this was relatively rare in late-onset PTLD (3 of 3 vs. 1 of 7). All patients were initially treated with reduction of immunosuppression, with at least one additional treatment modality used, mainly chemoimmunotherapy. Eight patients attained complete remission. With a median follow-up of 17 months, 8 patients died, mainly from treatment-related causes rather than disease progression.
  
  
  CONCLUSIONS
  Our cohort of lung transplant recipients demonstrates a trend of late-onset PTLD with the majority of patients who died of treatment-related causes rather than disease progression. Therefore, substantial efforts should be focused on treatment-related mortality reduction.
authors.affiliation: 1 Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel. 2 Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 3 Pulmonary Institute, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel. 4 Institute of Pathology, Rabin Medical Center, Petah-Tikva, Israel. 5 Address correspondence to: Eli Muchtar, M.D., Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel 49100.
authors.forename: Eli
authors.initials: E
authors.lastname: Muchtar
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
authors.forename: Liat
authors.initials: L
authors.lastname: Vidal
authors.forename: Ron
authors.initials: R
authors.lastname: Ram
authors.forename: Ronit
authors.initials: R
authors.lastname: Gurion
authors.forename: Yivgenia
authors.initials: Y
authors.lastname: Rosenblat
authors.forename: Ilana
authors.initials: I
authors.lastname: Bakal
authors.forename: Ofer
authors.initials: O
authors.lastname: Shpilberg
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D016041:Heart-Lung Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D016040:Lung Transplantation / Q000009:adverse effects* / Q000401:mortality; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents